Modern management of pituitary prolactinomas

Abstract

Although any form of pituitary tumour, either hormone-producing or non-functioning, can occur in women of reproductive age the most important clinically, and by far the most prevalent, are prolactin secreting pituitary tumours — prolactinomas. It is a fascinating phenomenon that the identification of prolactin as a hormone distinct from pituitary growth hormone, the availability of reliable radioimmunoassays for serum prolactin and the development of effective medical treatment to control hyperprolactinaemia all occurred virtually simultaneously in the early 1970s. Since then much has been learned about the pathogenesis, natural history and management of prolactinomas although the aetiology of these tumours still remains obscure. In the following pages the management of pituitary prolactinomas will be discussed with particular reference to induction of ovulation in women with hyperprolactinaemic amenorrhoea. There is persuasive evidence that medical management of hyperprolactinaemia, even when associated with the presence of a large pituitary tumour, is, in most cases, both effective and safe.